Heart Patients Should Be Routinely Screened for Depression

Jerry Kennard Health Pro
  • Depression is approximately three times more common in patients following a heart attack. Despite this, only half of heart doctors say they treat depression and many patients who are diagnosed with depression are left untreated.

     

    The American Heart Association (AHA) has taken up the case by calling for all heart patients to be regularly and routinely screened for signs of depression. The American Psychiatric Association is backing the call by recommending that patients who screen positive for depression should be treated and monitored by a careful coordination of trained clinical staff.

     

    Add This Infographic to Your Website or Blog With This Code:

    Over the past 40 years, over 60 studies have consistently shown a link between coronary heart disease and depression. It is estimated that up to 20 percent of heart patients meet the criteria for major depression. Rates for women are higher and younger women appear to have a particularly high risk. Depression triples the risk of non adherence to treatments and participation in cardiac rehabilitation.

     

    There is no direct evidence to link screening with better outcomes relating to cardiovascular complications, but depression is associated with poorer quality of life and increased morbidity and mortality.

     

    The AHA Advisory Committee recommends that heart patients be evaluated by use of a simple two item questionnaire:

     

                Over the past 2 weeks, how often have you been bothered by any of the following problems?

     

    (1) Little interest or pleasure in doing things.

    (2) Feeling down, depressed, or hopeless.

     

    If the person responds "yes" to either, the recommendation is that they be screened further by a nine item Depression Screening Scale:

     

                Over the past 2 weeks, how often have you been bothered by any of the following problems?

     

    (1) Little interest or pleasure in doing things.

    (2) Feeling down, depressed, or hopeless.

    (3) Trouble falling asleep, staying asleep, or sleeping too much.

    (4) Feeling tired or having little energy.

    (5) Poor appetite or overeating.

    (6) Feeling bad about yourself, feeling that you are a failure, or feeling that you have let yourself or your family down.

    (7) Trouble concentrating on things such as reading the newspaper or watching television.

    (8) Moving or speaking so slowly that other people have noticed. Or being so fidgety or restless that you have been moving around a lot more than usual.

    (9) Thinking that you would be better off dead or that you want to hurt yourself in some way.

    Questions are scored: not at all = 0; several days=1; more than half the days=2; and nearly every day=3. Added together, the item scores give a total score for the severity of depression.

     

    Depending on the score obtained, the patient may simply be monitored for signs of improvement or worsening of symptoms. Higher scores would alert staff of the need for a more formal diagnosis.

     

    Source:

    Lichtman, J.H., Bigger, T., Blumenthal, J.A., Frasure-Smith, N., Kaufmann, P.G., Lesperance, F., Mark, D.B., Sheps, D.S., Barr Taylor, C., Froelicher, E.S. (2008) Depression and Coronary Heart Disease. Recommendations for Screening, Referral, and Treatment. Circulation. Sept 29.

     

Published On: February 20, 2009